International Journal of Advanced Medical Sciences 01(01) 01-05, 2016

An Open Access Journal

International Journal of Advanced Medical Sciences

www.measpublishing.co.uk/journals/IJAMS

Knowledge, Attitude and Practice of Contraception among Medical and Pharmacy

Students in Nnamdi Azikiwe University Anambra State
H. C. Osuala a, S. A. Nwabueze b, E. O. Osuala c,*, E. C. Azuike b, E. D. Adinma b, B. N. Egenti d, F. N.
Osuala e
a
Department of Medicine, Faculty of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus Nigeria.
b
Community Medicine Department, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus Nigeria.
c
Department of Nursing Science, Faculty of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, Nigeria.
d
Department of Community Medicine, Faculty of Medicine, University of Abuja, Abuja, Nigeria.
e
Department of Pharmacognosy, Faculty of Pharmacy, Madonna University, Elele Campus, Nigeria.

*
Corresponding author at E. O. Osuala, Department of Nursing Science, Faculty of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus, Nigeria,
E-mail address: euniceosuala@yahoo.com (E. O. Osuala)

Abstract: Article Information:

Young adults run the most risk of unplanned pregnancy, due to lack of awareness to see a family planning provider. Keywords:
This poses a major challenge, as the end result may be induced abortion which is still claims lots of lives till date, Medical and pharmacy students
hence leading to high maternal mortality rate. On the other hand if the pregnancy is not aborted, the result is maternal Contraception
death due to complications of pregnancy, early parenthood, school drop-outs, poverty and malnutrition. Adequate Attitude
knowledge, positive attitude and right practice of contraception among youths will go a long way to combat these Practice
challenges. The doctors, pharmacists and other health care providers have a significant role. The study was carried out
to determine the knowledge, attitude and practice of contraception among medical and pharmacy students of Nnamdi
Azikiwe University, Anambra State, Nigeria; in view of providing better knowledge, attitude and practice of
contraception during the course of training, as this will equip them to help the public understand the consequences of
unwanted pregnancies and its prevention. Stratified random sampling technique was employed to select 350 students,
175 from each faculty. Ethical approval was obtained. A 32 item, self-administered, structured questionnaire was used.
Descriptive analysis was done using SPSS version 20.
Findings showed that majority of the students were aware of contraceptives- 100% and 99.4% of medical and
pharmacy students respectively. 62.9% of the former and 52.6% of the later have heard of emergency contraceptives.
There was a positive attitude towards contraception among the two groups. 69.4% and 55.7% of sexually active
medical and pharmacy students respectively use contraceptives. It is therefore recommended that Family planning
clinics be made available and accessible in the different tertiary institutions, as this will help to meet the sexual health Submitted: 31 Dec 2015
needs and problems of students as every woman within the reproductive age, married or single is at risk of maternal Revised form: 25 March 2016
death, hence the need for contraceptive use to prevent unintended pregnancy which leads to a barrage of events that Accepted: 25 March 2016
result in maternal death. Available Online: 25 March 2016

1. Introduction
Contraception, also known as birth control or fertility control, are methods
or devices used to prevent pregnancy, while the process of deciding in
detail, provision and its use is known as family planning [1]. Contraception
has been in existence for thousands of years through various cultural and
traditional practices, such as prolonged breastfeeding and abstinence.
However these practices were very strong in enforcing child spacing for
improving health of mothers and children and not for limiting family size
[2]. Abstinence-only sex education does not appear to be effective [3].
Effective contraception became available only in the 20 th century [4] and
entails comprehensive sex education and access to birth control methods.
This decreases the incidence of unwanted and unintended pregnancies,
hence aids in limiting family size, reducing the rate of occurrence of
pregnancy in medically unfit women, short inter-pregnancy interval and
teenage pregnancy.
Youths and adolescents who become pregnant also have same or similar
issues as we have in teenage pregnancy, which is pregnancy in human
females under the age of twenty, at the time that the pregnancy ends
[5].These pregnancies usually occur outside marriage in developing
countries, but may occur in marriage. Pregnant youths face many of the
same obstetrics issues as other women. However, they have additional
medical concerns which may include: uterovesical fistula, obstructed labour
and its complications, low birth weight, premature labour, pre-eclampsia
and severe anaemia. They also face social implications which include:
lower educational levels, higher rates of poverty, social stigma and
malnutrition [6] .
It was recorded in 2012 that 57% of women of child bearing age want to
avoid pregnancy (867 of 1520); about 222 million women however were
not able to access birth control, 53 million of whom were in the sub-
Saharan Africa, and 97 million of whom were in Asia [7].This results to54
million unplanned pregnancies and nearly 80,000 maternal deaths a year
[8].
Part of the reasons that many women are without birth control, is that many
countries limit access due to religious or political reasons [4] ;another
contributor is poverty. Due to restrictive abortion laws in sub-Saharan
Africa, many women turn to unlicensed abortion providers for unintended
pregnancies, resulting in about 2-4%, obtaining unsafe abortions each year
[9].
According to a study by Monjok et al [10] the prevalence rate for
contraceptive use in Nigeria is approximately 11%–13%. This rate is very
low in spite of the high rate of sexual activity and widespread awareness of
the various contraceptive methods among Nigerian adolescents and youths.
Medical and pharmacy students (undergraduates), also belong to this
category- adolescents and youths.
Most young adults run the risk of unplanned pregnancy, due to lack of
awareness to see a family planning provider. This poses a major challenge,
as the end result may be induced abortion which is still claiming lots of
lives till date, hence leading to high maternal mortality rate. At the other

1
end of the “rope”, when pregnancy is not aborted, the result is maternal
death due to complications of pregnancy, early parenthood, school drop-
outs, poverty and malnutrition. There is need to curb this ugly trend.
Adequate knowledge, positive attitude and right practice of contraception
among youths will go a long way to curb these challenges. The doctors,
pharmacists and other health care providers have a significant role to play.
If properly trained Medical students would become future opinion leaders
in health policy and would help the public to understand the consequences
of unwanted pregnancies and abortion, there is therefore a dire need to
ascertain their knowledge, attitude and practice of contraception, in order to
institute the right notion, improve knowledge and establish appropriate
practice among them, even during the course of training. This also applies
to the Pharmacy students who at graduation, qualify to produce and
dispense drugs, contraceptives inclusive. What more due to increasing
incidence of unwanted pregnancy, unsafe abortions, sexually transmitted
infections (STIs) and human immune deficiency virus (HIV), especially
among the adolescents and youths; the need to elicit their knowledge,
attitude and practice of contraception, undergraduates inclusive, became
necessary. This will make known the modalities for further education of
students on different forms of contraceptives, proper use of such
contraceptives, side effects and sustainability of the contraceptives for each
individual. This would go a long way to aid the achievement of the
Sustainable Development Goal 3, indicator 3.1 which is: to improve
maternal health and to combat HIV/AIDS, malaria and other diseases,
respectively.
2. Methodology
The study was carried out in Nnamdi Azikiwe University (NAU), Nnewi
and Agulu Campuses, on the Medical and Pharmacy students. The
institution is located in South Eastern part of Nigeria in Anambra State.
Only the second and third year students (pre-clinical students) of the
department of Medicine and faculty of Pharmacy were purposefully
selected for the study as the fourth year to sixth year students (the clinical
students), were on clinical postings in another location. However, during
the period of the research, the fourth year Pharmacy students were on
Student industrial work experiences (SIWES).Second year to final year
medical students have a total number of 430 persons; with 78 students in
second year, 82 in third year, 86 in fourth year, 76 in fifth year and 106 in
600level; While that of Pharmacy is a total of 435 with 148 in second year,
97 in third year, 105 in fourth year and 85 in fifth year. However, during the
period of the research, the fourth year Pharmacy students were on SIWES.
A descriptive cross-sectional design was adopted in this study. A stratified
sampling technique was used to conduct the study. There was already
Table 1: Knowledge of respondents on contraception
Course of study
Medicine
Frequency
existing stratum of classes which are 200 level, 300level, 400level, 500level
for both departments, and 600level for medicine. Simple random technique
was then used to select equal number of students from each faculty; this
number was then divided equally into the different strata (levels). Since the
fourth year Pharmacy students were away during the period of study, the
number of persons who were supposed to be selected from the class was
now selected equally from the other three available classes. Using the
formula for sample size for a comparative Study [11] a sample of 350
students was drawn with 175 from each faculty comprising of 92 males and
83 females from Faculty of Medicine; and 82 males and 93 females from
Faculty of Pharmacy. Self- administered, structured questionnaires was
used, with instructions to guide its filling.
3. Results
The findings on demography showed that the mean age of respondents from
faculty of medicine is 23 years while the modal age is 22 years.The mean
age of respondents from faculty of Pharmacy is 21 years while the modal
age is 21 years. Majority of the respondents are single.
Table 1 showed that majority of the respondents had heard about
contraceptives. In assessing the meaning and types, there were multiple
responses. The condom and oral contraceptive pills were observed to be the
contraceptive methods many of the respondents were aware of. Many had
heard of emergency contraceptive. There were multiple responses to the
meaning and types of emergency contraceptives.
The frequency increased with increase in level of study as shown in Figure
1. Figure 2 show that 72% of males and 47.9% of females use
contraceptives. 52.6% have the knowledge of respondents on emergency
contraception as shown in Table 2. Similarly, Table 3 demonstrated that 0.6
% of all the respondents had an unplanned pregnancy which resulted in an
abortion and Table 4 listed that 69.8% and 61.8 % of Medical and
Pharmacy students claim to use contraceptive always.
Results also demonstrated that the Prevention of fertilization is the most
known mode of action of contraceptives as shown in Figure 3. 4.6% and
11.4 % of medical and pharmacy students respectively stated that taking
salt water after intercourse would prevent pregnancy as listed in Table 5.
Similarly, Table 6 shows that 68.0% and 57.7 % of medical and pharmacy
students respectively think that every sexually active youth should use
contraceptives.
Statistically there was no statistical significance between respondents’
course of study and knowledge, attitude and practice of contraception (P =
0.317, 0.148 and 0.199 respectively.
Pharmacy
Percent % Frequency Percent %

Have heard about contraceptives

175
yes 100.0% 174 99.4%
0
no 0.0% 1 0.6%

Meaning of Contraceptive
Methods of preventing unwanted pregnancy 170 97.1% 161 92.0%
Methods of preventing sexually transmitted infections including HIV 69 39.4% 29 16.6%
Methods of birth spacing 78 44.6% 37 21.1%
Methods that improve sexual gratification 9 5.1% 10 5.7%
Knowledge of types of contraceptives
condoms 168 96.0% 137 78.3%
Oral contraceptive pills 160 91.4% 139 79.4%
Implants 118 67.4% 62 35.4%
Abstinence 90 51.4% 77 44.0%
Injectable 102 58.3% 52 29.7%
Withdrawal method 107 61.1% 78 44.6%

2

Figure 1: Respondents who have heard of emergency contraception based
on Level of Study
4. Discussion
The Medical and Pharmacy students reported knowing about emergency
contraception. Awareness level was also high. This corresponds to findings
in the study carried out by Aziken M et al [12] on knowledge and
perception of emergency among female Nigerian undergraduates in
University of Benin, Nigeria where 58% of respondents knew about
emergency contraception. Overall in this study, there was an increased in
knowledge with increase in level of study. This may be dependent on what
level family planning is introduced in their progammes. There is need for
these students through whom the information will be disseminated to be
introduced to reproductive issues earlier in their programme. There was
positive attitude to contraception as both medical and pharmacy students
respectively think that every sexually active youth should use
contraceptives. Findings show that among the sexually active respondents,
only 69.4% of medical students and 55.7% of pharmacy students use
contraceptives as shown in Figure 4. Unfortunately practice is poor as cases
of abortion were noted despite their level of awareness as shown in Figure
5. This might be due to misconceptions as some stated that taking salt water
after intercourse would prevent pregnancy. Religion and culture of the
people may also be a contributory factor as contraception is not discussed
openly. Liberal education on contraception should be encouraged like other
health topics.

Figure 2: Knowledge on modes of action of contraceptives

Table 3: Knowledge of conditions in which pregnancy will not occur
Table 2: Knowledge of respondents on emergency contraception Course of study
COURSE OF STUDY Medicine Pharmacy
Medicine Pharmacy Frequency % Frequency %
Intercourse unde
Freq Perce Fre Percent 0 0.0% 1 0.6%
r shower
uenc nt% que % Taking salt water
y ncy 8 4.6% 20 11.4%
after intercourse
Heard of emergency Yes 110 62.9% 92 52.6% Lactation 132 75.4% 81 46.3%
contraceptive method Douching after i
no 65 37.1% 83 47.4% 26 14.9% 19 10.9%
ntercourse
Meaning of Emergency Contraceptive
Drugs taken 24 hours before unprotected
intercourse to prevent pregnancy
11 6.3% 11 6.3%
Drugs taken 24 hours after unprote
cted intercourse to prevent pregnan 38 21.7% 27 15.4%
cy
Drugs taken on the same day of un
18 10.3% 12 6.9%
protected intercourse
Measures taken 73 41.7% 58 33.1%
immediately after unprotected sex
Knowledge of types of Contraceptives
IUCDS 29 16.6% 6 3.4%
Implants 4 2.3% 7 4.0%
High dose estrogen 35 20.0% 17 9.7%
Progesterone only 50 28.6% 25 14.3%
Combined oral contraceptives 65 37.1% 48 27.4% Figure 3: Prevalence of contraceptive use among sexually active
Respondents
3
Table 4: Respondents’ attitude towards contraception
Course of study
Medicine Pharmacy
Frequency % Frequency %
Would you attend outrea
ches and seminars on re
productive health if held 146 83.4% 165 94.3%
in your school
Do you think every sexu
ally active youth should
use contraceptives 119 68.0% 101 57.7%

Would you use contrace

ptives irrespective of its 84 48.0% 68 38.9%
known side effects
Would you tell a friend
about contraceptives if a 164 93.7% 158 90.3%
sked
After graduation when y
ou have qualified would Figure 5: Outcome of non use of contraceptive among sexually active
you promote the use of c 127 72.6% 104 59.4% respondents
ontraceptives 5. Conclusion
Adequate knowledge, positive attitude and right practice of contraception
Table 5: Types of contraceptives Used among youths will go a long way to combat the challenges of unplanned
Course of Study pregnancy. The doctors, pharmacists and other health care providers have a
Medicine Pharmacy significant role to play. The majority of students in this study were found to
Contraceptives used by sexu have good knowledge on contraception and a positive attitude towards use
ally active Respondents N = 43 N=34 of contraceptives among the sexually active students in the two groups was
established, but this did not translate to an increased level of use. The
ORAL CONTRACEPTIVES 8 18.6% 7 20.6% proportion of students using contraceptives was average, making them
CONDOM 43 100.0% 27 79.4% vulnerable unwanted pregnancies and sexually transmitted infections.
IMPLANTS 0 0.0% 0 0.0%
Young adults run the most risk of unplanned pregnancy, due to lack of
INJECTABLES 0 0.0% 0 0.0%
IUCDS 0 0.0% 0 0.0% awareness to see a family planning provider. It is therefore recommended
SAFE PERIOD 4 9.3% 1 3% that Family planning clinics be made available and accessible in the
WITHDRAWAL METHOD 6 14% 3 8.8% different tertiary institutions, as this will aid to meet their sexual health
More reliable 14 32.6% 13 38.2% needs. Liberal education on contraceptives and its use among youth need to
Easy to use 32 74.4% 18 53% be encouraged through Government policy and curriculum review. There is
More sensational 0 0.0% 2 5.9% need to strengthen the training of doctors and pharmacists and other health
Less side effects 24 55.8% 19 55.9%
care professionals on contraception, to enable them to provide quality
Table 6: Reasons for non-utilization of contraceptives among sexually
active respondents counselling services on choice and proper use of contraceptives.
Course of study References
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